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No millennium should be allowed to pass without a change or two. From this issue, ADC has a new cover, the table of contents moves inside, and key papers are summarised on the opening page. Published papers will generally be divided into four main sections: community child health, public health, and epidemiology; general and specialist paediatrics; laboratory research; and methodology. We have appointed US and European based associate editors to strengthen our international links, now that nearly half our circulation is abroad.
eADC (www.archdischild.com) now receives more “hits” each month than paper copy sales, and from January 2000, letters to the editor will become “Rapid responses” on the web site. Responses will be screened for obscenity, libel, and irrelevance (infrequently encountered with our respectable correspondents) but no corrections will be made to spelling, grammar or dubious statistics—so be warned; we will then select and edit letters for publication in the paper version. Shortly you will be able to link directly to Pediatrics from our website. We promise authors a quicker turnround time as our editorial staff make more and more use of email to communicate with referees, authors, and the editorial offices.
A change of editor always mean a shift in emphasis. This editor invites authors to write papers that are shorter, have a message beyond “further research is needed”, and use the active voice wherever possible.
Please let me know what you think of the changes (preferably by email to). We also welcome submissions and suggestions for the front cover illustrations ofADC and the Fetal and Neonatal edition—the only caveat being that the copyright fee should not be too high.
First sacred cow to the slaughter
David Hall reports on a consensus meeting on growth monitoring of children, which almost reached a consensus (page 2). He looks at the value of monitoring growth of children older than 2 years and concludes that the best time to screen is at school entry. Equipment, training, and quality control are crucial. Sophisticated techniques such as parental height adjustment are not recommended and standard referral of those over the 99.6th centile is not necessary. Before screening can become effective an agreed protocol is needed for investigating schoolaged children below the 0.4th centile. Perhaps the most contentious comment is that routine growth monitoring to detect centile crossing is too insensitive and non-specific to be regarded as screening.
Aussie couch potatoes and compliant Finns
On page 16, Lynch et al from New South Wales describe the changes in body mass index (BMI) in Australian primary schoolchildren. As BMI correlates with obesity and adverse lipid profiles as well as tracking into adult life, the authors believe there are important implications for future cardiac health. From 1911 to 1950 Australian children changed little in size. By 1976 they were a bit more beefy. This had accelerated by the time of survey of 8000 children in 1985 and continues to rise. Ethnicity seems of little importance. The findings echo those from the US and many European countries.
Can education reverse this trend? Perhaps it depends on perceived benefits and parental discipline. A Finnish team (page 21) found the parents of newly diagnosed diabetic children were remarkably compliant with the prescribed diet. They ate 2–3 times as much potato, rye, fibre, and vegetables than controls. The authors suggest other family members would do well to stick to the same diet.
Lead safe for once
I am grateful to Macdonell and colleagues (page 50) who refer to “plumbosolvency”—a word not knowingly used inADC last century. They have examined the hypothesis that domestic water lead levels are associated with neural tube defects (NTD). Live birth data by postcode were linked to water supply lead levels measured from samples kindly supplied by Glaswegian mothers from their kettles. Mothers from the most deprived areas had higher rates of NTD in their offspring but water lead levels had no effect. Glaswegian women have not increased their folic acid ingestion, so why the pregnancy prevalence of NTD has fallen overall remains a mystery.
A clinic transformed
Congratulations to Dr Abdul Rashid Gatrad from Walsall who shows us how clinical audit, when done carefully and acted upon, can make a real difference to outcome (page 59). Gatrad has reduced the rate of outpatient non-attendance by two thirds, and by nearly three quarters in Muslim Asian children. He provides eight easy steps to achieve this task and reminds us of how cultural awareness can be effective.